Applied Ergonomics 1994, 25 (1) 3-16

A field methodology for the control

of musculoskeletal injuries
Jacqueline L Reynolds*, Colin G Drury* and Richard L Broderick t

*State University of New York at Buffalo, Department of Industrial Engineering, Buffalo,

NY 14620, USA
tVF Corporation, Wyomissing, PA 19610, USA

A methodology is presented for the evaluation of jobs p r o n e to cumulative t r a u m a

disorders (CTDs) and manual material handling ( M M H ) injuries, which combines
various tested ergonomics m e t h o d o l o g i e s into a single, coherent p r o g r a m m e . This
multi-step procedure is based u p o n the collection of quantitative data that are used to
evaluate ergonomic changes with respect to biomechanical risk, perceived comfort,
productivity and quality. A m e t h o d for prioritizing changes, related to cost-benefit
analysis, is proposed to guide the selection of e r g o n o m i c changes in order to maximize
the potential for injury reduction u n d e r specified cost constraints. T h e ten-step
methodology has been extensively applied in industry, leading to examples and a case
study.

Keywords: Cumulative trauma disorders, manual material handling, risk assessment and
control, musculoskeletal injuries

Introduction workforce and lower the workers' compensation costs.

In the USA, the Occupational Safety and Health
Administration (OSHA) has categorized musculo-
skeletal injuries among its ten highest priorities for
reduction (Millar, 1988), and equivalent interest in
their control is evident worldwide. Musculoskeletal
injuries generally inflict the muscles, ligaments,
tendons, or nerves, and occur when excessive stresses
are placed on a human's musculoskeletal system. A
majority of these injuries are the result of repeated
stress (Kroemer, 1989). There are two major classes of
musculoskeletal injury, and although related, they
often require different ergonomic interventions.
Cumulative trauma disorders (CTDs) develop over
time due to repetitive stress to a joint, typically the
upper extremities (Putz-Anderson, 1988; Kroemer,
1989). Manual material handling (MMH) injuries can
result either from a single acute event or, more
commonly, as a result of cumulative strain. In other
words, many MMH injuries can be considered as CTDs
(Konz, 1990). Within this methodology, owing to
previous research and the available analysis methods,
CTDs and MMH injuries are analysed separately. Thus
the assessment of all MMH injuries, regardless of
whether they are the result of cumulative exposure, will
be considered independently.
Many companies have found the need to address
these injuries, and specifically CTDs and MMH injuries,
by implementing formal programmes to protect their
These programmes include risk assessment and control
of CTDs and MMH injuries, medical management, and
education (OSHA, 1990). This paper presents an
integrated methodology that can be utilized within a
formal programme for the risk assessment and control
of CTDs and MMH injuries. In addition, a procedure is
included within this methodology to evaluate interven-
tion strategies with respect to their cost-benefit. This
methodology, an expanded version of that presented in
Drury and Wick (1984) and Drury (1987), has been
successfully applied in several industries.
Overall programme objectives
The methodology used here is a participative one,
involving a team of operators and plant personnel
(Vink et al, 1992). Before any on-site work can start
there must be a clear indication of the programme
goals. For the methodology presented here, the goals
are:
1 to provide quantitative data that will demonstrate the
effectiveness of ergonomic interventions in a short
period of time at a small number of workplaces;
2 to provide a self-sustaining means to evaluate and
change a whole plant in a systematic manner;
3 to ensure that plant personnel are able to become the
primary resources for future analysis and intervention.
The methodology is based upon measuring the
exposure to risk of musculoskeletal injuries. Convert-

Applied Ergonomics 1994 Volume 25 Number 1 0003-6870/94/01

0003-14 ~) 1994 Buuerworth-Heinemann Ltd 3
A field methodology for the control of musculoskeletal injuries: J L Reynolds et al
tional safety outcome measures (such as workers'
compensation claims) are not used in this evaluation as
they are only sensitive to large improvements, on many
workstations, over a long period of time. The task-
analysis-based methodology provides a significant
advantage, in that it is possible to evaluate ergonomic
improvements before large-scale implementation
occurs.
This is a 'before-after' methodology in which a job is
evaluated, ergonomieally modified, and re-evaluated.
Quantitative data are collected and analysed so that
ergonomic improvements can be assessed. As far as
possible, this methodology was developed from a set of
pre-existing components in the ergonomics literature.
This aids comparisons between studies, and facilitates
the future ergonomics growth of practitioners. In
addition, the authors have found that practitioners can
be easily trained in the application of this methodology
and that companies appreciate a formal methodology
so that projects proceed in a planned manner, consistent
across plants.
The goals presented are most typically achieved by a
team of key plant personnel (for example, supervisors,
operators, safety professionals, engineers). This team is
augmented during job analysis by the operators who
are incumbents of the job being analysed (Drury,
1987).
The results from a recent field investigation, which
involved the analysis of several tasks in a tyre manu-
facturing plant, will be utilized throughout the paper to
illustrate each of the ten steps in the methodology. A
case study will follow, which summarizes the 'before-
after' data for a selected task analysed at a large
apparel manufacturing corporation where this methodo-
logy has been implemented.
The ten-step methodology
1 Review musculoskeletal injury data
The first step is to ascertain that musculoskeletal
injuries are indeed the problem at hand, rather than
task performance (quality or process control for
example). Accident/injury data can be obtained by
reviewing plant medical records or, in the USA, OSHA
Log forms (No. 200, for example). Safety records may
also provide adequate data, although they are normally
associated with accidents (single events). Thus these
records may not be helpful in the identification of
CTDs and many MMH injuries, which develop over
time (Putz-Anderson, 1988).
The procedure outlined in Drury and Brill (1983) can
be employed to identify accident patterns. Accident/
injury data are grouped into a small number of
repetitive scenarios or patterns. This analysis enables
the identification of problem jobs, and their associated
injuries. For example, Figure 1 presents accidents that
occurred over a one-year period in the department
manufacturing truck tyres. The predominant scenario
was pain/strain injury to the back, resulting from first-
stage tyrebuilding. It was apparent that the primary
concern in this department was MMH injuries, and
thus accident data were found to be an acceptable
source of information.
4 Applied Ergonomics 1994 Volume 25 Number 1
This analysis provides ergonomic insights that can be
applied at the outset to focus the subsequent evaluation.
The selection of jobs to be analysed and the type of
analysis (CTD, MMH, or both) to perform can be
guided by this investigation.
2 Ergonomic review
An ergonomic audit or review is a screening tech-
nique by which potential ergonomic problems can be
identified. A checklist is normally employed to guide in
this gross job evaluation. There are checklists (for
example, Drury, 1990) that are broad in scope and
investigate all job and task components (such as
lighting, CTD potential, and MMH requirements),
whereas other checklists are specifically tailored to
investigate a single ergonomic concern (eg Lifshitz
and Armstrong, 1986). A majority of these checklists
are developed for a qualified engineer or ergonomist to
complete.
Alternatively, a checklist may be developed that
operators can complete. For example, Table 1 presents
a checklist, developed for an apparel corporation, and
primarily aimed at tasks that possess a risk of CTDs and
MMH injuries. This provides a natural entry point for
operators to begin contributing to the ergonomics
process. Operator involvement is crucial to the eventual
acceptance and success of an ergonomics programme.
Their insights are generally extremely valuable, owing
to their level of familiarity with the job.
These tools allow the workplace to be examined to
determine whether there are any additional risk factors
present, including: vibration, contact with sharp edges,
and cold temperatures (Putz-Anderson, 1988; Kroemer,
1989; OSHA, 1990). In addition, other workplace
features, such as lighting, may affect the injury
potential, as they may directly or indirectly cause
biomechanical injuries. For example, the visual
demands of tasks often cause an operator to flex the
spine and neck in an attempt to bring the eyes and task
closer together. Improved task visibility, by lighting
and contrast changes, can often eliminate this flexion
and remove one source of postural stress. Workplace
analysis should be a systematic effort to eliminate
mismatches between task demands and any human
subsystem, although the musculoskeletal subsystem is
of primary concern in this analysis.
This assessment provides general data that can be
utilized along with the accident/injury data to assist in
selecting jobs that need to be analysed in detail.
Moreover, this audit can provide valuable insights into
the nature of potential ergonomic shortcomings if
detailed analysis and redesign are necessary.
3 Task and operator selection
The accident/injury analysis and ergonomic audit
provide valuable guidance in the selection of jobs and
operators for evaluation, but they are not the only data
required for a decision. Jobs that have been injury-free,
but exhibit symptoms associated with CTDs and MMH
injuries, are also candidates for early examination.
Initially, a job with some probability of success
should be selected or at least one in which there is a
 A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

u
13 '
O-Sy~ Servicer 1stSlage"rB

Umy TB
11-20ym

6-10ym 2ridStageTB
Years of Service Job

Other

(') Leg4oot

15
Conlus
E~
Body Part Injured
Injury (') cited • 1

Unknown 0 da~
>1 0 d a ~

6-10days

Days Out

Figure 1 Accident data for tyrebuilding department categorized according to years of service, job, injury, body part injured,
activity performed when accident occurred, and number of days missed due to accident

possibility of change. At the outset of the programme
all personnel, from management to operators, are
observing to determine whether ergonomics works;
thus a successful start can be pivotal. In addition, a job
that has the possibility of inexpensive solutions can
illustrate that ergonomics does not necessarily incur
high implementation costs, and can be performed in
house with minimal delays. Finally, the chosen jobs
should not have an obvious solution. There is no point
in ergonomic analysis when there is an obvious fix
available without ergonomic intervention. After these
initial evaluations are complete, more difficult opera-
tions can be tackled with a trained team and an
enthusiastic plant.
The choice of operators can be particularly important
to the evaluation. The time required for the chosen
data-collection procedure will dictate the number of
operators selected for analysis. Many of these procedures
are time-intensive and will force the selection of a
limited number of operators. Selecting a representative
operator(s) can be problematic, for large variability in

Applied Ergonomics 1994 Volume 25 Number 1 5

A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

Table 1 CTD/MMH checklist

Sewing tasks Task~workforce

Does the task require frequent extreme motions of the back, neck, shoulder or wrists?
Examples include: reaching above shoulder level, reaching behind the body,
continually bending or twisting the back, neck, shoulders, or wrists.
Are the elbows raised and unsupported for much of the time?
Do the hands/wrists/arms come in contact with any sharp, or non-rounded, edges
on the table/machinery?
Does the task require gripping with the fingers?
Do the knee/foot controls require force?
Answer if task is sit-down:
Is leg clearance restricted?
Are the foot/legs unsupported or your thighs sloping down in the front (there is no
footrest or it is not able to be used)?
Does the chair or table restrict the thighs?
Is the back unsupported (no backrest or not being used)?
Is the chair height fixed (not adjustable or only adjustable using tools)?
Answer if task is stand-up:
Does the knee/foot control require you to support your weight on one foot for
much of the time?
Is the standing surface hard and unsupported (no mat)?
Is the work surface height fixed (not adjustable)?
Answer if task requires frequent use of hand tools:
Does tool require wrist/hand bending or twisting?
Does tool vibrate?
Can tool only be used with one hand?
Does tool handle end in palm?
Does tool handle have any sharp, or non-rounded, edges or corners?
Does tool operation involve only two or three fingers?
Does tool operation require continuous or high force?
Is tool continually held in the hand?
Environment
Is the total lighting level inadequate at your workplace?
Is there glare, from surface reflections or other light sources, which affects your
ability to see your work?
Is there any vibration at your workplace?
Is the temperature uncomfortably hot or cold in the winter?
Is the temperature uncomfortably hot or cold in the summer?
Manual material handling Answer if the task involves lifting/lowering or pushing/pulling:
tasks Does the task require you to perform more than 5 lifts/min?
Are any of the loads unbalanced?
Does the task require you to lift items over your head?
Does the task require you to lift items off the floor?
Does the task require you to reach out with your arms while lifting/lowering or
pushing/pulling?
Does the task require you to twist or bend while lifting/lowering or
pushing/pulling?
Is the floor wet or slippery?
Is the the floor in poor condition (surface cracks, etc.)?
Is the area obstructed so that you have to modify your lifting/lowering or
pushing/pulling postures?
Is protective clothing ever unavailable when needed?
Is the temperature uncomfortably hot or cold in the winter?
Is the temperature uncomfortably hot or cold in the summer?

the operators' methods is the rule rather than the
exception (Kilbom and Persson, 1987). An experienced
operator who utilizes the 'correct method' and does not
have any visibly bad habits should be selected, or the
charge could later be levelled that the operator's
problems are their own fault so that no ergonomic
intervention was required. If more than one operator
can be analysed, operators who represent the most
common working methods can be selected. The same
operator(s) should be utilized in the subsequent re-

6 Applied Ergonomics 1994 Volume 25 Number 1

 A field methodology for the control of musculoskeletal injuries: J L Reynolds et al
analysis, for no two operators perform the task using
exactly the same method or body posture. An obvious
final criterion is that the operator must be a willing
volunteer. Coerced data are technically suspect and
morally dubious.
4 Data collection and analysis
The evaluation of a workplace consists of the
collection and analysis of three types of data: bio-
mechanical, subjective comfort, and performance. The
principle of using multiple evaluation tools is that they
can show different aspects of the whole task-operator-
machine--environment system. When the same aspect is
covered by more than one tool, convergent validity can
be shown. For example, similar findings should result
in the determination of awkward postures through
biomechanical analysis and body part discomfort.
Biomechanical data As discussed earlier, this
methodology is based on measuring exposure to risk;
thus the risk factors associated with these jobs must be
identified. Recent epidemiologic studies have found a
fundamental dose-response relationship between force
and repetition and the development of CTDs (Silver-
stein et al, 1986; 1987). In addition, awkward postures
have been identified as a possible factor in the
development of CTDs (Putz-Anderson, 1988). Thus
data analysis will focus on measuring these three
primary risk factors: posture, force, and repetition.
The data analysis is based upon a task analysis,
involving the formal comparison of task demands with
human operator capabilities. A biomechanical task
analysis would identify the risk of a musculoskeletal
injury by indicating when the biomechanical demands
of the task (posture, force, and repetition) exceed the
capabilities of the operators.
CTD research has not yet progressed to a stage that
allows the prediction of the operators' ability to
withstand the primary CTD risk factors (Moore et al,
1991). For example, it is not known how many times
the wrist can be flexed 45°, while gripping with a 2 kg
Table 2 First stage tyrebuilding task description and analysis performed
Subtask Analysis
Get right bead CTD
Get knife/cut innerliner CTD
Get knife/cut first ply CTD
Get knife/cut second ply CTD
Apply stickers CTD
Remove tyre carcass from press CTD/MMH
Carry tyre carcass CTD/MMH
Place tyre carcass on truck CTD/MMH
Get knife, cut sidewall CTD
Get stitcher, stitch sidewall CTD
Get left bead, place liner CTD
Get right bead CTD
Hang right bead CTD
Remove tyre carcass from drum CTD
Place on press CTD/MMH
Applied Ergonomics 1994 Volume 25 Number I
force, before a CTD is sustained. Thus there are no
guidelines outlining operator capabilities that can be
used to compare with the measured task demands.
Analysis will instead focus on reducing the value of
each of these risk factors, under the assumption that
decreasing the value of the risk factors will decrease the
risk of CTDs. Comparison is possible for some MMH
jobs, because of the better understanding of human
operator capabilities in relation to risk factors in such
jobs (NIOSH, 1981). Thus injury predictions can be
made based upon a direct comparison of MMH task
demands and operator capabilities.
There are two forms of task description and analysis:
CTD and MMH. The CTD analysis can be utilized to
investigate the risk of all jobs that present a risk of
cumulative injury. This includes many MMH jobs, but
the more advanced theory development in the area of
MMH, with respect to human operator capabilities,
allows additional models to be applied to these jobs.
Table 2 presents the first-stage truck tyrebuilding task
description and indicates the analysis performed on
each subtask. Further examples will focus on this task
(on which a majority of accidents in that area occurred),
as indicated by the accident analysis (Figure 1).
The results of the CTD task analysis performed on
the first-stage tyrebuilding task are presented in Table
3. Posture data were obtained using the methods
prescribed by Drury (1987). This approach involves
manually measuring body angles into standardized
categories related to the magnitude of a deviation from
a neutral position. Videotape provides the most efficient
medium by which to collect these data for two reasons.
First, the work operation can be recorded and analysed
off line, so as not to interrupt production. Second, it is
possible to slow down and stop the rapid motions
typical of musculoskeletal-injury-prone jobs (OSHA,
1990). From the videotape, the job is decomposed into
task elements, similar to the procedure followed in
industrial engineering time-study methodology, and
extreme postures are recorded.
Roll change subtask Analysis
Pick up empty inner liner roll MMH
Place empty inner liner roll MMH
Pick up empty sidewall roll MMH
Place empty sidewall roll MMH
Pick up empty ply roll MMH
Place empty ply roll MMH
7
A field methodology for the control of musculoskeletal injuries: J L Reynolds et al
Manual methods such as this one involve minimal
investment and can be applied by plant personnel with
minimal training. Dependent upon the task, this
method can be time-intensive. The primary disadvantage
of this technique is that a continuous record of posture
cannot be obtained. The analyst must attempt to
capture exteme angles; thus the task breakdown should
be based upon capturing extreme postural deviations.
The reliability of this method has not been extensively
examined. Corlett et al (1979), using a similar manual
method, found test-retest correlations of recording
stationary postures to range from 0.67 to 0.88 after
minimal training.
Computer-aided systems and more elaborate auto-
mated systems have been developed in an effort to
address some of the drawbacks of manual systems and
are described in detail elsewhere (Keyserling, 1986;
Fragala and Marcus, 1991). These methods vary in
cost, data collection and analysis time, training and
equipment, and reliability.
Force data were collected manually according to
OSHA (1990). This method entails subjectively estim-
ating and categorizing force into gross categories (low,
excessive). This force information may be estimated
from the videotape. Under high force conditions, the
operator's hands appear to be bulging, or their knuckles
are white. This information may also be obtained by
asking the operator. For most field applications, in
which only relative 'before-after' data are necessary,
this simple method of force assessment should be
adequate. For more specific data, a hand dynamometer
can be used for force reproduction (Drury and Wick,
1984), at which subjects have been found to be
accurate (Yonda, 1986). Using these manual methods,
the force information is obtained for each task element.
In situations that require more precise force data
(such as epidemiologic studies), a more elaborate
assessment technique such as EMG (Armstrong et al.
1979) may be necessary.
The collection of repetition data is normally dictated
by the postural recording technique. If a manual
technique is utilized to obtain postural data, as in this
case, quantitative frequency information is estimated
from industrial engineering sheets, which indicate the
number of parts produced per day. This information
can be multiplied by the postural deviations to deter-
mine the frequency of each posture (Drury, 1987).
There has been limited development of analysis
procedures. Summary statistics have been utilized to
describe the accumulated effect of postures and forces
over time (Moore et al, 1991). Drury (1987) developed
a measure of daily damaging wrist motions (DDWM) to
measure the total number of wrist deviations combined
with a grip or external force over the course of a
working day. In addition, the duration of static postures,
which is an additional risk factor for CTDs, can be
identified (Putz-Anderson, 1988; Kroemer, 1989;
OSHA, 1990). As previously discussed, there are no
standards for CTDs; thus, a majority of analyses focus
on 'before-after' comparisons (see section 9).
Postural deviations, force and repetition increase the
risk of CTDs, although it is not known how risk varies
8 Applied Ergonomics 1994 Volume 25 Number I
as these factors act independently or in conjunction
with one another. There is evidence to suggest that
there is a risk of CTDs when these factors are present,
regardless of their interaction. Silverstein et al (1986,
1987) found both force and repetition to act independ-
ently to increase the risk of CTDs, and found a
multiplicative effect when these factors were both
present. Thus daily wrist exposure (DWE), used to
quantify and summarize CTD data, may be defined as
the union of grip force and postural deviation multiplied
by the daily frequency:
DWE -- (grip force + postural deviation) X frequency
This measure, similar to that employed by Drury
(1987), accounts for all postural deviations and grip
forces regardless of whether they occur simultaneously;
Drury's measure only considered postural deviations
that occurred in conjunction with grip forces.
Similarly, the daily exposure of other joints may be
quantified by considering posture and frequency:
DE = postural deviations X frequency
Grip forces and postural deviations are categorized
with respect to magnitude:
• Grip force: 1 = low force, 2 = excessive force
(OSHA, 1990);
• Posture: zone 1 -- 10% or less range of motion, zone
2 = 10-25% range of motion, zone 3 = 50% or
greater range of motion (Drury, 1987).
The postural deviations, along with the daily exposures
(DWE for wrists and DE for all other joints) are
indicated in Table 3. Force is indicated by an * if it is
excessive (force = 2); otherwise low force was involved
(force = 1).
Referring to Table 3, the D W E for the right wrist on
the 'get knife' subtask would be calculated as follows, if
there is low force, zone 2 postural deviation and the
daily output is 135 units:
DWE = (1 + 2) X 135 = 405
Likewise, the daily exposure for the right shoulder, for
'get right bead', when there is zone 2 postural
deviation, and the daily output is 135 units:
DE = (2) X 135 = 270
Total exposures for each joint, listed at the bottom of
Table 3, can be determined by simply summing the
exposures for all subtasks.
At present, there is no theory supporting these
equations; they only have face validity, for posture,
force and repetition are summarized in one measure.
However, they focus the analyst on potentially injurious
parts of the task, and thus can be utilized in the
generation of design requirements.
As discussed earlier, extensive research has allowed
the determination of the M M H capacity of workers for
some tasks (NIOSH, 1981; Ayoub et al, 1987). Thus the
task demands for some M M H jobs can be directly
compared with human capacities to determine the risk
of injury. Generally, biomechanical, physiological and
psychophysical criteria have been utilized to determine
 A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

Table 3 CTD analysis, first-stage tyrebuilding: deviation (zone) and daily exposures

Subtask Right wrist Left wrist Right shoulder Left shoulder Back

Get right bead Abduct (2) 270

Get knife Ulnar (2) 405 Abduct (2) 270
Cut inner liner Radial (2) 405
Get knife Ulnar (2) 405 Abduct (2) 270
Cut first ply Extend (2) 405 Abduct (2) 270
Get knife Ulnar (2) 405 Abduct (2) 270
Cut second ply Radial (2) 405 Abduct (3) 405
Apply stickers Flex (3) 405
Remove tyre Extend (2)* 540 Extend (2)* 540
from press
Get knife Ulnar (2) 405 Abduct (2) 270
Cut sidewall Radial (2) 405
Get stitcher Abduct (2) 270
Flex (2) 270
Get left bead Abduct (2) 270
Extend (3) 405
Get right bead Abduct (3) 405
Flex (2) 270
Hang right bead Abduct (3) 405
Remove tyre Radial (2)* 540 Radial (2)* 540
from drum

Total exposure 2700 2700 3645 675 405

*Indicatesexcessiveforce

acceptable MMH capacities and are reviewed in detail
elsewhere (NIOSH, 1981; Ayoub et al, 1987).
The NIOSH method was utilized to analyse the
MMH components of the tyrebuilding job (Table 4).
This method provides guidelines that incorporate
biomechanical, physiological and psychophysical criteria
(NIOSH, 1981). The action limit (AL) and maximum
permissible limit (MPL), which indicate the upper
limits of human operator capabilities, are based upon
an 'ideal' weight, which is adjusted for horizontal and
vertical location of the object, travel distance, and
frequency. The actual weight lifted can then be directly
compared with these limits to determine whether or not
a job is likely to cause injury. The procedure can be
utilized to determine the acceptability of a MMH task
as well as to obtain quantitative measures by which to
measure a job, before and after ergonomic change.
Table 4 indicates that all of the roll change operations,
as well as several of the subtasks within the major cycle,
require forces that exceed the action limit. This
information can be utilized for the generation of design
requirements, as well as to measure improvement in
the 'before--after' data.
Subjective comfort data Perceived comfort data allow
the assessment of how the operator actually feels, and
assist in validating the biomechanical data. Further-
more, this stepallows another opportunity for operator
involvement. The body part discomfort (BPD) scale
has been utilized extensively to evaluate a wide range
of jobs.
The BPD chart (Corlett and Bishop, 1976) (Figure 2)
has been found useful in measuring operator comfort in
a wide range of tasks (Corlett and Bishop, 1978; Drury
and Coury, 1982; Sauter et al, 1991). The operators rate
each body part on a scale from 1 to 5 to indicate the
level of discomfort. Data can be analysed to determine
the body parts most stressed in the task to assist in
validating the biomechanical data. Various analysis
techniques are described in Corlett and Bishop (1976)
and Drury (1987).
The scale can be administered at intervals throughout
the working period, to measure discomfort over time.
In manufacturing conditions, readings four times per
day just prior to scheduled rest breaks give good
results. The collection of these data for one week
'before' and 'after' any ergonomic change is normally
adequate to obtain reliable results (Drury and Wick,
1984). A new scale sheet should be provided each time,
to avoid response bias. The authors have found these
scales to provide quick, accurate data, and operators
can use them with minimal instruction.
Postural discomfort data have been found to increase
immediately following ergonomic changes (Drury and
Wick, 1984; Drury, 1987), perhaps due to a change
in posture that is forcing different muscles to be used.
After several weeks, these values should decrease,
assuming the 'after' workplace is in fact improved; if
they do not, then further modification is needed.
Performance data The collection of performance data
allows the assessment of the impact of ergonomic
changes on productivity and quality. Although the
primary goal of this procedure is to reduce the risk of

Applied Ergonomics 1994 Volume 25 Number 1 9

A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

Table 4 Manual material handling analysis Formally stating these requirements can assist in the
generation of solutions and reduce the probability of
Subtask AL MPL Weight overlooking potential solutions (Drury, 1987). Work-
place redesign has been found to be more successfully
Remove tyre carcass 24.96 74.88 29* accomplished by a team that may include engineers,
from press medical personnel, supervisors, maintenance staff and
Place tyre carcass on press 24.96 74.88 29* operators. Thus this step allows the entire team to see
Carry tyre carcass 40.42 121.26 29 the problems and contribute during redesign without
Place tyre carcass on truck 19.12 57.37 29* being distracted by changes that do not address the
(fourth level) basic problem of that specific workplace.
Place tyre carcass on truck 21.51 64.53 29*
(third level) 6 Alternative solutions
Place tyre carcass on truck 30.7 92.12 29 Alternative solutions should be generated to address
(second level) the design requirement stated above. Typically, genera-
Place tyre carcass on truck 31.76 95.27 29 tion of these alternatives is done by the ergonomics
(first level) team using a participative methodology (eg Eason,
Pick up empty inner liner 28.20 84.60 60* 1990; Wilson, 1991). Engineers on the team provide the
roll detailed designs of the alternatives, and assist in
Place empty inner liner roll 22.28 66.83 60* obtaining cost estimates. As indicated, there may be
Pick up empty s:aewall roll 25.40 76.19 35* several alternative solutions for each requirement.
Place empty sidewall roll 17.18 51.55 35* Fundamental ergonomics principles, as well as engineer-
Pick up empty ply roll 21.46 64.39 90** ing and administrative controls specifically aimed at
Place empty ply roll 32.4 97.2 90* reducing the risk of CTDs and MMH injuries, should
be followed. The provision of design principles and
*ExceedsNIOSH action limit (AL); **exceedsNIOSH maximum guidelines is beyond the scope of this paper; however,
permissible limit (MPL) there are several texts from which these data can be
obtained (eg NIOSH, 1981; Chaffin, 1987; Putz-
Anderson, 1988; Konz, 1990; OSHA, 1990).

biomechanical injuries, productivity and quality are at

least equal in importance for most companies and
should, at a minimum, not suffer following ergonomic
interventions. Although experiences have indicated Left 2
~_ ~Eyes Right
that ergonomic changes can decrease the risk of injury,
while simultaneously maintaining or increasing product- Neck
ivity and quality (Drury and Wick, 1984), this is still a --7"%-
real concern of plant personnel. Managers with tight Shoulders
budgets and operators on incentive systems, both
typical of repetitive tasks, need some reassurance that
their livelihood will not be threatened.
Operator productivity can be measured as a percent-
age of time standards in order to eliminate any effects
due to style or product changes (Drury, 1987). Drury
~ Mid back
Lower arms
Lower back
and Wick (1984) found four to six weeks of data
collection before and after a change was adequate to P----Hand
obtain reliable results. Quality measures are most
reliable, when they are associated with individual
operations and operators in order to allow valid Thighs
'before-after' comparisons.

5 Design requirements
Design requirements are positive statements about
what needs to be accomplished in the redesign of a Legs
workplace (Drury, 1987). Based upon the information
obtained in the previous steps, the design requirements
should be formally listed. The objective is to reduce the
risk of injury by reducing and/or eliminating the value
of the risk factors (postural deviations, forces and I 5 5
repetitions).Table 5 lists the design requirements, based I I I
upon both a CTD and MMH analysis, for the tyre- Just noticeable Moderate Intolerable
building job. Notice that these are not solutions, but pain/discomfort pain/discomfort pain/discomfort
requirements, and that there may be several alternative Figure 2 Body part discomfort form (adapted from Corlett
solutions that address each requirement. and Bishop, 1976)

10 Applied Ergonomics 1994 Volume 25 Number l

 A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

Table 5 Design requirements and corresponding alternative solutions prioritized by accident data

Number of Ergonomic
accidents priority Design requirements Alternative solutions

27 1 Reduce forces while lifting/carrying rolls to (a) Automatic low tyrebuilding machine
and from machine (b) Manual low tyrebuilding machine
(c) Lightweight storage rolls for rubber

4 2 Reduce forces when removing tyre carcass (a) Alternative lubricant

from drum

3 3 Reduce forces when lifting tyre carcass onto (a) Conveyor system
third and fourth levels of truck (b) Redesign existing rock

2 4 Reduce shoulder deviations in get-bead (a) Adjustable bead rack

operations

1 5.1 Reduce forces when placing/removing tyre (a) Eliminate press operation
carcass to/from press (b) Change orientation of press
(c) Automatic press control

1 5.2 Reduce wrist/shoulder deviations during (a) Knife redesign

cut operations

0 6.1 Reduce wrist/shoulder deviations during get (a) Relocate knife holder
knife/stitcher operations

0 6.2 Reduce back flexion during sticker operation (a) Change method

Engineering techniques, where possible, should be
utilized to provide a permanent design that induces safe
operating practices (Konz, 1990; OSHA, 1990). In
addition, administrative solutions can be readily applied
to address the risk of injury immediately at all
workplaces. However, the various administrative tech-
niques differ in their effectiveness. It is the authors'
experience that changes in procedures, such as the
incentive or injury reporting systems, provide effective
permanent solutions. Administrative techniques that
require continuous re-enforcement (such as training)
are not always effective as stand-alone solutions.
However, in conjunction with engineering controls,
these administrative measures can also be effective. In
addition, their cost is normally reduced, for the
workplace is designed to induce safe techniques. For
example, if a workplace is designed so that a MMH job
can be naturally performed without having to bend
over (for example, use carts to keep boxes off the
floor), an operator will not have to be continually
trained in proper lifting procedures. Table 5 lists the
alternative solutions generated for each design require-
ment developed from the tyrebuilding example.
7 Selection and prioritization of alternatives:
cost-benefit analysis
As shown in Table 5, there may be several alternative
solutions that address each design requirement. These
interventions can vary in implementation time and cost,
from simple, straightforward and inexpensive to more
substantial, sophisticated investments. In most
instances, there is a finite amount of money appropri-
ated to ergonomics projects; thus there is a need to
select the alternatives that will maximize the reduction
in injury for a given budget. A procedure has been
developed that will assist in clarifying this selection
process. The two factors needed in any such procedure
are the effectiveness and cost of each alternative
solution.
To determine the effectiveness, the design require-
ments can be prioritized according to a quantitative
measure (accidents, DWE, injuries or back compressive
forces, for example). This was done in Table 5. The
primary concern in this department was MMH injuries,
and accident data were found to be an acceptable
quantitative measure. Otherwise, other data may be
utilized (plant medical records, for example). Figure 1
indicates that 38 first-stage tyrebuiliders were injured
over the past year. These injuries could be matched to
specific design requirements to determine the number
of accidents that occurred because a specific design
requirement was not addressed. Hence the potential
effectiveness of design solutions can be prioritized to
give an 'ergonomic priority'. For other situations, other
effectiveness measures (such as DWE reductions) may
be more appropriate.
Having developed an effectiveness measure, cost
data are needed. Costs should be on the same basis:
per workplace rather than totals for a plant or
department. Some solutions involve major redesign (a
new automated handling system, for example) and thus
necessarily affect many workplaces, whereas others
(such as new chairs) involve a separate cost at each

Applied Ergonomics1994 Volume 25 Number 1 11

A field methodology for the control of musculoskeletal injuries: J L Reynolds et al
workplace. Similarly, all solutions should have the
same time basis, so as to incorporate both initial costs
and ongoing costs (such as maintenance) or savings
(such as improved throughput).
An effective method for presenting effectiveness and
cost data together to the ergonomics team, and to any
higher decision-making levels, is to combine the two
measures in a single graph. Figure 3 shows such a plot,
with alternative solutions marked to correspond to
Table 5. From this graph, it can be seen that some
solutions cost little while being highly effective (2a, for
example), but others cost more and are less effective
(5.1c). The graph may be divided into five regions to
assist in selecting solutions as follows:
• Region O: negligible cost. Solutions should be
implemented regardless of their priority, provided
they have no negative impacts.
• Region I: low cost, high priority. Solutions should be
implemented, provided they have no negative
impacts, for they address high ergonomic priorities at
low cost.
• Region II: high cost, high priority. Dependent upon
the budgetary constraints, solutions should be con-
sidered by implementation. Although these are high-
cost solutions, they are also high in injury-reducing
potential. Solutions in this region may be considered
during long-term planning: for example, during the
purchase of new machinery.
• Region III: low cost, low priority. Dependent upon
the budgetary constraints, solutions may want to be
Ic
°Z"
3b
el
4a
~ -4 OI
1 as closely as possible. If possible, the same analyst and
b,.
.u
5.1o 5.1b 5.1c
E should be utilized. The administration of the perceived
0 I
6.2o 6.1a
u3-6
Ill
-8
-I0 I I ' I I I I I
0 90 160 180 1200 3500 17000
3000
Implementotion cost ( $ )
Figure 3 Categorization of design solutions according to
ergonomic priority and implementation cost
12
considered for implementation. Even though the
potential for injury reduction is low, they are low-
cost.
Region IV: high cost, low priority. Solutions will
most likely be avoided, because they are low in
injury-reducing potential and are high in implementa-
tion cost, but they may be implemented for other
reasons besides ergonomics, such as reduced direct
labour costs, or improved process control.
8 Fitting trials
Once design alternatives have been selected, they
should be initially tested off line using a simulated
workplace. This need not be a 'real' workplace
(producing product), but a set-up that allows quick
adjustability. Wooden or cardboard models of the
required tools and machines, along with adjustable
benches and chairs, can be used to produce an
adequate mock-up (Drury, 1987).
Anthropometric data provide a starting point to
obtain initial workplace dimensions. As any design
must accommodate the range of workers rather than
the average, several operators over a range of body
dimensions should be fitted to the set-up to determine
the final design dimensions. Anthropometric data
typically provide insufficient realism for working
postures, so that the life-size adjustable mock-up is a
necessary step in refining the workplace design. Corlett
and Bishop (1978) describe this procedure in detail.
This step also allows the discovery of design con-
straints and opportunities that may have been over-
looked, allowing the design to be fine-tuned.
Mechanical support for the design team (maintenance)
is crucial at this point, and can provide invaluable
guidance on practical design issues. Following these
Ib Io
trials, a working prototype should be placed on the
production floor. Ample time (at least 1-2 weeks)
should be allowed for operator adjustment before re-
analysis is attempted.
30 9 Re-analysis and evaluation
•
Data collection and analysis (step 4) should be
repeated to obtain similar quantitative measures on the
redesigned workplace, replicating the 'before' analysis
the same operator, producing the same product mix,
comfort forms and the collection of the productivity
and quality data should follow the same time schedule.
This care is necessary so that only ergonomic changes
IV are measured by the design. Such study designs can also
benefit from control groups, although this is rarely
possible in the close social system of a single department
in a plant. Although it is not always possible to relate
the effects observed unequivocally to the ergonomic
solutions tested, the attempt should be made as part of
the ongoing feedback to the ergonomics team.
I I I f I I / Statistical testing can be utilized to determine whether
91000 130000 180000 there is a significant difference between the 'before'
and 'after' workplace with respect to the postural and
performance data (Drury, 1987). Continuous variables
(such BPD and productivity) can be analysed using a t-
Applied Ergonomics 1994 Volume 25 Number 1
 A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

test, or a non-parametric equivalent, whereas discrete

measures (such as number of defects) can be tested
using the chi-square statistic.
Evaluation allows management to assess quantitat-
ively the impact of ergonomic change on the risk of
injury, operator comfort, productivity and quality. In
addition, the effectiveness of particular ergonomic
solutions can be evaluated, and a repertoire of successful
interventions can be developed and applied to other
situations.

10 Implementation
Once improvement has been proven on a prototype
workstation, the ergonomic changes should be imple-
mented on all the workstations in the area. From the
preceding analysis, management can be assured that
this process will provide a reduction in the risk of
injury, and have a predictable effect on productivity Figure 4 Half-felled inseam job before ergonomic change
and quality.
This step can be difficult and will involve a close
cooperation between management, supervisors, oper- In addition, 'before-after' BPD data were collected on
ators, and maintenance (instruction, training, motiva- four operators, three times throughout the day, for
tion, and follow-up) to ensure that the changes are eight days.
accepted. Operators should be allowed to provide A formal cost-benefit analysis as discussed in section
individual suggestions about their workplace during the 7 was not necessary in this case, for the selection of
final retrofitting, to assist in the acceptance of the alternatives was obvious based upon the state of
changes. In any plant where current ideas on continuous technological advancement in this area. The develop-
improvement are utilized (eg Drury, 1991), it should be ment of automatic felling machines, which can produce
realized that the design produced by this process is the styles required at this plant, have not progressed to
merely the basis for future change. Of course, as a stage at which the desired level of quality can be
implementation proceeds, long-term changes in out- ensured. Furthermore, all felling machines currently
come measures such as injury incidence and severity available are similar to the models currently being used
should be tracked. Thus, unequivocal cause-and-effect and thus would not address the existing ergonomic
relationships can be determined more easily by using concerns; hence the purchase of new machines
other departments and plants as control groups. Note (alternative a) would not have been warranted. All the
however that the methodology proposed here is for remaining alternatives, listed in Table 6, w e r e imple-
action rather than research; the aim is to develop a mented on four prototype workstations (Figure 5).
process of ergonomic change that has validity, and not
to make plants into sites for testing research hypo- The stand-up workplace, primarily aimed at reducing
theses. bending in the neck-back area and shoulder flexion,
included:
A case study
An ergonomics programme was initiated at VF
Corporation, a large apparel manufacturer, in an
attempt to improve worker well-being and reduce
injury costs. The methodology outlined above was
utilized as a guide in the development of the workplace
analysis and hazard prevention/control components of
their programme. 'Before' and 'after' biomechanical,
subjective comfort and performance data from a
representative task at a VF division will be presented.
Based upon a review of OSHA log forms, the half-
felled inseam job, at a divisional plant, was selected for
ergonomic evaluation (Figure 4). On this job, per-
formed by 18 operators, there were 14 injuries during
the past year (1991), accounting for 6480 lost hours and
incurring $72 361 in injury costs. A majority of these
injuries were the result of cumulative trauma. A CTD
analysis was performed on one operator, utilizing the
manual data-collection procedures and the analysis
methods outlined in this paper. Design requirements
were generated by a team of key personnel (Table 6). Figure 5 Half-felled inseam job after ergonomic change

Applied Ergonomics 1994 Volume 25 Number 1 13

A field methodology for the control of musculoskeletal injuries: J L Reynolds et al

Table 6 Design requirements and corresponding alternative solutions prioritized by daily exposures

Ergonomic
priority DWE DE Design requirements Alternative solutions

1 41 236 Reduce neck/back flexion and lateral bending (a) New felling machine
during all operations (b) Stand-up existing machines
(c) Tilt machine

25 376 Reduce left shoulder flexion/adduction during (a) New felling machine
sew operations (b) Stand-up existing machine
22 204 Reduce right shoulder flexion/abduction during
sew operations

30 927 Reduce right wrist flexion/radial deviation during (a) Tilt existing machine
sew operations
16 653 Reduce left wrist ulnar/radial deviation during (a) Automatic thread cutter
dispose, get, and load operations

• air-powered adjustable stand to allow the operator evaluation over the first five months has shown that
quickly and easily to change the machine height and there have been no injury costs incurred on this job.
tilt (the machine tilt was incorporated to improve Productivity, measured in average hourly earnings for
vision at the point of work and further reduce neck approximately six months 'before' and 2 months 'after',
and back bending and wrist deviations during the sew has significantly increased from $7.34 to $8.56 (n --- 8,
operations); 7* = 35, p = 0.01).
• knee-activated machine control and leg-activated
Conclusions
presser foot and roller, in place of a foot pedal, to
allow both legs to support the body; The methodology discussed above provides a system-
atic procedure by which musculoskeletal injuries can be
• work aids to present and support the material at a
recognized, diagnosed and controlled. This procedure
proper height;
is unique, for it enables control measures to be
• anti-fatigue mats to reduce the stress on legs; implemented and evaluated quantitatively, as well as
rapidly. Through the process of application, the
• automatic thread cutter to reduce left wrist devia-
methodology naturally encourages and provides the
tions during the dispose, get and load operations.
An 'after' CTD analysis was performed on the same
operator, and the results indicate a reduction in daily
wrist exposures (DWE) and daily exposures of the DWE
35000 [
other joints (DE) (Figures 6 and 7). It is not appropriate
to perform statistical testing on these variables, for they
are a function of the work method, not a random 30000
variable (Drury, 1987).
'Before-after' BPD data were collected on the four 25000
operators producing product on prototype work-
stations. Normality assumptions were suspect, thus
paired differences were compared using the non- 20000
parametric Wilcoxon signed-rank test. The body part
discomfort values were found to be significantly
15000
reduced in the shoulder-arms (n = 4, T + = 0, p = 0.125)
and wrists-hands (n = 4, T' = 0, p = 0.125). There was
a significant increase in discomfort in the legs (n = 4, 10000
T + = 0, p = 0.125), as well as a non-significant decrease
in the back, presumably due to the implementation of
the stand-up workplace. However, some of these 5000
values were obtained only two days after the imple-
mentation of the new workplace, and it is the authors'
experience that initial leg discomfort is common in Left Wrist Right Wrist
stand-up workplaces, and subsides within a few weeks
(Figure 8). ~IE Before ~ After
Since implementation across all half-felled inseam Figure 6 Daily wrist exposure (DWE) before and after
workstations in the plant in January 1992, long-term ergonomic change

14 Applied Ergonomics 1994 Volume 25 Number I

 A field methodology for the control of musculoskeletal injuries: J L Reynolds et ai
DE
50000
40000
30000
20000
10000
Shoulders Neck/Back
1 Before I---1 After
Figure 7 Daily exposure (DE) values for the shoulders, back
and neck before and after ergonomic change
opportunity for a cooperative effort between all levels
of plant personnel (such as operators, engineers and
supervisors). The programme becomes a plant effort,
thus increasing its probability of success. Lastly, and
most importantly, as evidenced in the case study, the
methodology works!
Acknowledgements
The authors wish to recognize VF Corporation,
particularly the VF Risk Management Task Force, for
making all pertinent information available for analysis
purposes and for their enthusiasm and active participa-
tion in the implementation of their ergonomics
programme.
References
Armstrong, T J, Chaffin, D B and Foulke, J A 1979 'A
methodology for documenting hand positions and forces
during manual work' J Biomech 12, 131-133
Ayouh, M M, Selma, J L and Jiang, B C 1987 'Manual
materials handling' in Salvendy, G (ed) Handbook of
human factors John Wiley & Sons, New York, pp 790-818
Chaffin, D B 1987 'Manual material handling and the bio-
mechanical basis for prevention of low-back pain in
industry - an overview' Am Ind Hyg Assoc J 48, 989-996
Corlett, E N and Bishop, R P 1976 'A technique for assessing
postural discomfort' Ergonomics 19, 175-182
Corlett, E N and Bishop, R P 1978 'The ergonomics of spot
welders' Appl Ergon 9 2.3-32
Corlett, E N, Madeley, S J and Manenica, I 1979 'Posture
targetting: a technique for recording working postures'
Ergonomics 22, 357-366
Drury, C G 1987 'A biomechanical evaluation of the repetit-
ive motion injury potential of industrial jobs' Sem Occup
Med 2, 41--49
Drury, C G 1990 'The ergonomics audit' in Lovesey, E J
Applied Ergonomics 1994 Volume 25 Number 1
Average BPD
0.5
0,4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
0.3 ..................................................................................................................................
0.2
0.1
0
Shoulders/Arms Wrists/Hands Legs
1 Before [ - - 7 Alter
Figure 8 Average body part discomfort severity values before
and after ergonomic change
(ed) Contemporary ergonomics Taylor & Francis, London,
pp 400-405
Dimly, C G 1991 'Ergonomics practice in manufacturing'
Ergonomics 34, 825--839
Drury, C G and Brili, M 1983 'Human factors in consumer
product accident investigation' Hum Factors 25, 329-342
Drury, C G and Conry, B G 1982 'A methodology for chair
evaluation' Appl Ergon 13, 195-202 --
Drury, C G and Wick, J 1984 'Ergonomie applications in the
shoe industry' Proc lnt Conf Occupational Ergonomics
pp 489-493
Euson, K A 1990 'New systems implementation' in Wilson,
J R and Corlett, E N (eds) Evaluation of human work
Taylor & Francis, London, pp 835-849
Fragala, G and Marcus, B A I991 'Quantifying risk factors
associated with cumulative trauma disorders' in Karwowski,
W and Yates, J W (eds) Advances in industrial ergo-
nomics and safety III Taylor & Francis, London, pp 121-
127
Keyserling, W M 1986 'A computer-aided system to evaluate
postural stress in the workplace' Am lnd Hyg Assoc J 47,
641-649
Kilbom, ~ and Persson, J 1987 'Work technique and its
consequences for musculoskeletal disorders' Ergonomics
30, 273-279
Konz S 1990 Work design: industrial ergonomics Publishing
Horizons, Worthington, OH
Kroemer, K I-I E 1989 'Cumulative trauma disorders: their
recognition and ergonomic measures to avoid them' Appl
Ergon 20, 274-280
Lifshitz, Y and Armstrong T J 1986 'A design checklist for
control and prediction of cumulative trauma disorder in
intensive manual jobs' Proc Hum Factors Soc 30th Ann Mtg
Human Factors Society, pp 837-841
Millar, D J 1988 'Summary of proposed national strategies
for the prevention of leading work-related diseases and
injuries, Part 1' Am J Ind Med 13, 223-240
Moore, A, Wells, R and Ranney, D 1991 'Quantifying ex-
posure in occupational manual tasks with cumulative
trauma disorder potential' Ergonomics 34, 1433-1453
15
A field methodology for the control of musculoskeletal injuries: J L Reynolds et al
NIOSH 1981 Work practices guide for manual lifting DHHS
(NIOSH) Publication No. 81-122, US Government Print-
ing Office
OSHA 1990 Ergonomics program management guidelines for
meatpacking plants US Department of Labor
Putz-Anderson, V 1988 Cumulative trauma disorders: a
manual for musculoskeletal diseases of the upper limbs
Taylor & Francis, London
Sauter, S L, Schleifer, L M and Knutson, S J 1991 'Work
posture, workstation design, and musculoskeletal dis-
comfort in a VDT data entry task' Hum Factors 33, 151-
167
Silverstein, B A, Fine, L J and Armstrong, T J 1986 'Hand
wrist cumulative trauma disorders in industry' Br J Ind
Med 43, 779-784
16
Silverstein, B A, Fine, L J and Armstrong, T J 1987 'Occu-
pational factors and carpal tunnel syndrome' A m J lnd
Med 11,343-358
Vink, P, Lourijsen, E, Wortel, E and Dul, J 1992 'Experi-
ences in participatory ergonomics: results of a roundtable
session during the llth IEA Congress, Paris, July 1991'
Ergonomics 35, 123-128
Wilson, J R 1991 'Design decision groups: a participative
process for developing workplaces' in Noro, K and Imada,
A (eds) Participative methods John Wiley & Sons, New
York, pp 81-96
Yonda, R A 1986 'An investigation of the human ability to
replicate task-produced forces on a cell load apparatus'
(unpublished manuscript)
Applied Ergonomics 1994 Volume 25 Number 1